DDHA 8113 Week 5 Departmental Influence Map Example

What Each Department Must Hand Over: An Influence Map for Merging Two Overnight Neurology Rotations, With the Two Warm Yeses That Never Reached a Schedule

Student Name

Walden University

DDHA 8113: Advanced Concepts in Healthcare Leadership

Instructor Name

Month Day, Year

What Each Department Must Hand Over: An Influence Map for Merging Two Overnight Neurology Rotations, With the Two Warm Yeses That Never Reached a Schedule

Purpose of the Map

Calder Valley Health's neurosciences service line, part of a fictional regional system, is merging the overnight general neurology rotations of its two larger hospitals into one shared rotation supported by video consults. The neurologists have agreed to a redesigned protocol. Whether the merged rotation works on its first night depends on eight departments, most of which do not report to the service line director. A conventional stakeholder map would place people on a grid of power and interest. This map is arranged differently, by department, because the merger needs things from departments rather than opinions from people. For each department it states the specific resource that department must release for the merger to function, the position its leaders have stated, and whether anything has actually been released. Bryson (2004) treats stakeholder analysis as worth doing to the extent that it alters a leader's next move, and this map is built to show where the next three weeks of effort must go.

Stated Support Versus Committed Resource

The distinction the map rests on is between saying yes and giving something up. A department head who says the merger is a good idea has spent nothing. A department head who assigns a technician, changes an order set or signs a credentialing file has spent time, attention or risk. Pfeffer (1992) describes power in organizations as resting heavily on control of resources that others depend on, and a merger of this kind is a long list of such dependencies. The map therefore records, for each department, the evidence that would show the resource has been released: a scheduled date, a changed system, a signed document.

The Map

Table 1

Influence Map by Department: Resource Required, Stated Position and Evidence of Release

Five departments have released what the merger needs, one has partly released it and two have stated warm support without releasing anything.

The Two Warm Yeses

The two departments that worry the director most are the two that sounded most enthusiastic. The telehealth and information technology director called the merger exactly the kind of project the team exists for and offered to present it at the system's digital strategy meeting. Three months later, no work order exists for the video carts, and the consult build in the electronic record is not in any release plan. Hospital medicine's section chief told the service line committee that hospitalists were tired of waiting overnight for in-person neurology consults and would welcome the change. The consult order set that would route requests to the shared rotation has not been touched, and no hospitalist has been trained.

In both cases the stated support was sincere. The cause is more ordinary. Each department has a queue, and the merger has not entered it. The telehealth team works from a prioritized request list governed by a committee on which the service line has no seat. Hospital medicine changes order sets through a pharmacy and therapeutics process that meets monthly and needs a sponsor to bring an item forward. Neither leader refused. Neither converted support into a place in the queue, and the director did not ask them to.

Ambivalence as an Asset

The south campus neurology group was the most reluctant department at the start and has since released everything the merger needs. In the study by Battilana and Casciaro (2013), people driving change gained most from strong relationships with people who were ambivalent about a change, and the south group's reluctance turned out to be ambivalence that could be worked with. Its lead neurologist argued about cover rules in detail, which meant she was already imagining the merged rotation. The director spent more time with that group than with any other, and the investment converted. The lesson for the two warm yeses is that enthusiasm without detail may be the weaker signal.

What the Map Changes

The map changes three things in the director's plan for the next three weeks. First, the director will ask the telehealth director to submit the cart request to the prioritization committee in her own name, with a target date, and will ask for a seat at the committee meeting where it is considered. Second, the director will ask the hospital medicine section chief to sponsor the order set change at the next pharmacy and therapeutics meeting and will draft the change for him. Third, the go-live date will be held until the carts are installed on at least two floors and the order set is live, because a merged rotation without video carts would send neurologists driving between campuses at night, which is exactly the burden the merger was meant to remove. Greenhalgh et al. (2004) concluded from their review that new practices spread in health services only as fast as the surrounding systems are prepared to absorb them, not only on the willingness of the people who adopt them.

Limits of the Map

The map records evidence of release at one point in time, and a department can release a resource and later withdraw it. Departments are also not uniform: a department head's stated support may not reflect the frontline staff who will do the work, as the uneven nurse training already shows. And the map gives no weight to informal influence, such as the respect a particular neurologist commands across both campuses. Those limits are acceptable for a planning tool, provided the map is updated every two weeks until go-live.

Conclusion

Eight departments must release specific resources for the merged rotation to work. Five have, one partly has and two have offered warm support without releasing anything. The two warm yeses are explained by queues the merger has not entered, and the director's next steps are to enter them with sponsors, drafts and dates. Go-live waits for evidence of release, not for further statements of support.

References

Battilana, J., & Casciaro, T. (2013). Overcoming resistance to organizational change: Strong ties and affective cooptation. Management Science, 59(4), 819-836. https://doi.org/10.1287/mnsc.1120.1583

Bryson, J. M. (2004). What to do when stakeholders matter: Stakeholder identification and analysis techniques. Public Management Review, 6(1), 21-53. https://doi.org/10.1080/14719030410001675722

Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. The Milbank Quarterly, 82(4), 581-629. https://doi.org/10.1111/j.0887-378X.2004.00325.x

Pfeffer, J. (1992). Understanding power in organizations. California Management Review, 34(2), 29-50. https://doi.org/10.2307/41166692